Healthcare Provider Details

I. General information

NPI: 1376451773
Provider Name (Legal Business Name): JARAH VAUGHAN JACQUAY MSN, RN, CNL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 EAST AVE
PENSACOLA FL
32508-5136
US

IV. Provider business mailing address

760 EAST AVE
PENSACOLA FL
32508-5136
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-7325
  • Fax:
Mailing address:
  • Phone: 850-452-7325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN9292708
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: